Provider Demographics
NPI:1861531170
Name:WEST SHORE UROLOGY ASSOC
Entity type:Organization
Organization Name:WEST SHORE UROLOGY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:LUMBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-596-9652
Mailing Address - Street 1:2039 INDIAN ROCKS RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-1035
Mailing Address - Country:US
Mailing Address - Phone:727-596-9652
Mailing Address - Fax:727-593-5128
Practice Address - Street 1:13201 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3518
Practice Address - Country:US
Practice Address - Phone:727-596-9652
Practice Address - Fax:727-593-5128
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371048300Medicaid
FLCB2137OtherRAILROAD MEDICARE
FL203305OtherAMERIGROUP
FL24767OtherBLUE CROSS BLUE SHIELD
FL371048300Medicaid